A human rights assessment of a large mental hospital in Kenya

Introduction: globally, human rights violations of persons with mental health conditions are rampant, and the quality of mental health services below that for general health services. The aim of this paper is to document the findings of an assessment of the quality of mental health services at the largest mental hospital in Kenya, and offer recommendations useful for service transformation. Methods: this was a cross-sectional study. Assessment was conducted guided by the World Health Organization (WHO) QualityRights Tool Kit, which assesses for compliance with five human rights themes drawn from the Convention on the Rights of People with Disabilities. Trained assessors collected data through document review, observation, and interviews with hospital staff and service users at Mathari National Teaching and Referral Hospital. The sample was composed of 64 interviewees. Results: overall, the facility was scored as "achievement initiated" indicating that there was evidence that steps had been taken to fulfil the five human rights themes but significant improvements were necessary. Five key gaps emerged: 1) the buildings and infrastructure were in a state of disrepair; 2) staffing was inadequate; 3) patients had no right to legal capacity; 4) there was gross neglect of patients as well as physical and verbal abuse; 5) there were no strategies in place to support community reintegration and independent living. Conclusion: significant improvements to infrastructure, staffing, and the quality of services are needed before the Mathari National Teaching and Referral Hospital meets the requirements of the Convention on the Rights of People with Disabilities.